The Torah’s Prescription for Healing
WebMD, a commonly consulted Internet source of medical information, devotes three pages to “Common Skin Rashes.” The site takes up the symptoms, diagnosis, and treatment of eczema, granuloma annulare, lichen planus, and pityriasis rosea, respectively. Should verbal descriptions be insufficient, the Mayo Clinic has posted a slide show, characterizing these and other disagreeable outbreaks as “not usually serious,” although they “may cause discomfort or pain, as well as embarrassment.” As for the etiology of the conditions, WebMD states in each case that “the cause . . . is unknown.”
Given the discomfort, discomfiture, and uncertainty that even mild skin eruptions can cause us nowadays, it should come as no surprise that they were a source of anxiety in ancient times. In this week’s parashah, that anxiety finds expression amidst an array of concerns about the human body and its functions. The purity laws in Leviticus 11 through 15, which digress from the narrative flow of the book,[i] are concerned with diet (chapter 11), reproduction (chapter 12), and bodily integrity (chapters 13 to 15, including property as an extension of the person).
In the context of the biblical cult, impurity arises out of perceived deviation from a “normal” state, skin eruptions and bodily emissions serving as obvious cases in point. Rituals of purification either signify or effectuate a return from “deviant” to “normal.” The destruction of the Temple and the concomitant end of Temple sacrifice eliminated both the need to remain in a state of ritual purity and the means of attaining that state. The biblical conceptions of normalcy and deviance, moreover, became increasingly obscure or alien to post-biblical sensibilities. As a result, alternative interpretations of the purity laws arose early in the history of interpretation.
At a glance, the opening chapters of Parashat Metzora seem like a biblical antecedent of WebMD. Leviticus 13 describes the disfiguring symptoms of צרעת/tzara`at, starting with “a swelling, a rash, or a discoloration” that “develops into a scaly affection” (Lev. 13:1). The text then goes into specific manifestations, instructing the priest as to the proper diagnosis in each case.
Whatever condition is designated by the term tzara`at, it is not “leprosy” or Hansen’s disease—a misunderstanding that may be traced to the Septuagint (the Greek translation of the Torah). In any case, the priest’s responsibility is not to identify the condition per se, but to determine whether or not it imparts impurity. In contrast to WebMD, Leviticus 14 prescribes a course of ritual action rather than medical treatment. The diagnostician is not a physician, after all, but a priest, and the rituals are to be undertaken only after the sores of the afflicted individual have healed (14:3). The purpose of the rituals is cultic purification (14:2), not medical treatment.
Isaac Caro (1458–1535) addresses this point in his Toledot Yitzhaq on Leviticus 14:2, where he writes that interest in the medical aspect of tzara`at “is inappropriate for our Holy Torah, which is concerned with spiritual ailments and not physical ones. Skin eruptions are the province of medicine, which is concerned with bodily health (beri’ut ha-guf), whereas the Torah’s concern is with spiritual benefit (to`elet ha-nefesh).” After an aside on the physical causes of skin diseases, Caro reiterates that they are not the Torah’s subject matter: “The Torah addresses tzara`at to teach that human ailments have two causes, one material (mi-tzad ha-homer) and the other spiritual (mi-tzad ha-nefesh),” and the Torah speaks only to the latter. A person of sound constitution whose affliction is spiritual “does not have to go to a medical doctor, but to a healer of the spirit.”
Today’s physicians are attentive to possible nonphysical causes of disease such as stress, anxiety, and depression, and many dermatological disorders have a psychosomatic component. According to the American Dermatological Association, “Studies link factors that affect our emotional well-being . . . to an increase in skin, hair or nail problems.” Or, as a practitioner puts it, “A dermatologist’s work would be incomplete if he/she did not consider and examine the whole patient, not only the physical body . . . but also the individual’s mind (the psyche or the psychologic aspects, ‘the soul’).”[ii] Lacking the resources and terminology of modern psychiatry to pinpoint the cause and potential cure of the “spiritual” malaise, Caro relies on the longstanding rabbinic notion that “it is brought on by evil speech.”[iii] He subdivides “evil speech” into three categories: statements that are malicious even if true (lashon ha-ra); second-hand gossip (rekhilut); and outright slander (dibbah). Then he argues with considerable ingenuity that three of the items designated for the rituals of purification in Leviticus 14:4 are intended to provide reparation for the three forms of evil speech: the slaughtered bird for lashon ha-ra; the live bird for dibbah; and the crimson stuff for rekhilut.
Other texts offer broader and more general etiologies of tzara`at. Leviticus Rabba 17:3 enumerates 10, possibly corresponding to the number of afflictions (nega`im) described in the parashah. The 10 causes are idolatry, illicit sex, bloodshed, profanation, blasphemy, embezzlement, theft of personal property, arrogance, evil speech, and casting the evil eye—each one of which the midrash exemplifies with a biblical story. The author of Midrash Tadshe (chapter 16)[iv] boils them down to three: envy (referring to Miriam in Numbers 12), greed (Gehazi in 2 Kings 5), and arrogance (Uzziah in 2 Chronicles 26).
Modern medicine is attentive to the relationship of mind and body: our psychological state unquestionably affects our physical condition. As the American Psychological Association admonishes us, “Pay attention to what your body is telling you about the state of your mind.” This week’s parashah offers a similar lesson with respect to spiritual well-being: we must be attentive to what our bodies are telling us about the condition of our souls. The author of Midrash Tadshe (chapter 17) asks why the priest is commanded to take two birds for the ritual of purification, slaughtering one and setting the other free (Lev. 14:5–7). He asserts that the slaughtered bird, dead and buried in the ground, symbolizes an infirmity that is gone for good. The live bird, on the other hand, serves as a reminder that reverting to the behavior that brought on the ailment in the first place could engender a relapse: just as the bird might return from the open country, so the affliction might recur. It therefore makes good sense to avoid thoughts, words, and actions that can trigger ill effects—sound advice that is conveyed in an odd and intriguing way in Parashat Metzora as refracted through the lens of traditional commentary.
The publication and distribution of the JTS Commentary are made possible by a generous grant from Rita Dee and Harold (z”l) Hassenfeld.
[i]The narrative resumes in Leviticus 16:1, harking back to chapter 10.
[ii]Quotation from Emiliano Panconesi, “Psychosomatic Factors in Dermatology: Special Perspectives for Application in Clinical Practice.”See also Philip D. Shenefelt, “Management of Psychodermatologic Disorders.”
[iii]For an excellent introduction to the concept of “evil speech” (lashon ha-ra) and its consequences, see David Golinkin, “Death and Life Are in the Hand of the Tongue.”